Supply issues

I have a 4 month old baby girl. She was a large baby, 9lbs 15 oz when I was induced at 38 weeks, 22 inches long. I was pressured to start formula in the hospital as she was jaundiced and required light treatment and daily follow up for the first couple weeks. Other than that she has been very healthy and latched well.
She has continued to be large, is now 18 pounds and I have struggled but been unable to meet her needs without some supplemental formula. This is probably for multiple reasons. I'm also a first time mom at 43 and she was a donor baby. She has a large appetite and often wants 8 ounce feedings if taking a bottle. We use slow nipples but she is insistent, especially if a long time since she ate. She goes 6 hours often at night now.
I nurse and pump and am back to work since 8 weeks. I pump about 6 times a day and nurse about 3. One of my pumping times is always in the middle of the night. I find I have to pump 30 to 40 minutes and get from 1 oz to rarely 8 ounces. Lately my pumps have been about 3 hours apart and I'm getting 2 or 2 and 1/2 ounces. These are not pumps that follow a nursing session, so I should be fuller. I take a lot of galactagogue herbs such as fenugreek, eat oatmeal everyday and drink plenty of water.
I wonder if power pumping for an hour is more beneficial at all if I already pump for 45 mins straight? I also do heat and compression. thanks

Re: Supply issues

Welcome to the forum!

Your age and the way your daughter was conceived shouldn't affect your ability to produce milk, unless you have some underlying medical condition like PCOS or thyroid issues that impacted your fertility. So I think you should probably put any "I'm too old" thoughts out of your mind, if they're there. (And I'm 38, so we're in pretty much the same boat!)

The thing that really jumps out at me from your post is that your baby will take HUGE bottles. A breastfed baby requires about 1.5 oz of milk per hour of separation from mom, so the only way a breastfed baby should take an 8 oz bottle is if she's going about 5 hours in between feedings. I'm guessing she isn't!

2-2.5 oz per pump session is actually typical output. If you need more milk, here are some suggestions:
- Use the best double electric pump you can afford, with correctly-sized shields, and make sure the pump is in perfect working order.
- Pump more frequently. More sessions per day will translate into greater yield. Many working moms end up pumping after feedings when they are with their babies.
- Pump for longer time periods- but keep in mind that frequency of pump sessions is often more important than duration.
- Co-sleep with your baby, and wake her in the night and nurse her if she doesn't spontaneously wake to feed. More nighttime nursing usually translates to better daytime supply.

Re: Supply issues

I don't think it would hurt to try a power pumping to simulate a growth spurt as opposed to 45 mins straight. How about playing with the suction level of your pump? That has made a difference for me. Usually once I have let down, I turn the suction up a few notches and that seems to help. Also - I had been using a Medela Pump In Style for the past 4 months. A co-worker recommended renting a Medela Symphony, and I rented one over the weekend. The first two or three days, I only noticed about an extra 1/2 ounce difference. The 4th and 5th days, I am now getting about an extra ounce (between both breasts). That said, the Medela Symphony feels much more gentle and I would have rented one from the get go had I known.

Re: Supply issues

Thanks for the suggestions. Mommal, My LO does go 6 hours sometimes between feedings, overnight. I get up and pump then even if she doesn't awake. I don't want to force feedings on her as we are already a little concerned about her weight. If you try to cut her off early from her feedings, she becomes very fretful. I have thyroid disease (hashimotos) but am tested regularly and am not on supplementation. I've been tested within the last 2 months or so. We do co sleep. She is in a co sleeper.
Joannafaith: I use a Madela PIS. I turn the suction up to where it starts to hurt, then back it down. The Symphony is a good thought. I also thought about getting a Freestyle. I can get one paid by insurance July 1. I could pump more often if I could do other things at the same time.

Re: Supply issues

I wonder if the formula has anything to do with it. I formula fed my first 3 babies and formula intake increases as the baby ages but I have learned that is not so with BF babies. I am feeding my newest baby nothing but BM and it is a totally different ball game when it comes to intake and how often baby eats..I dont know...it's just a thought...hope everything works out for you.

Happy Mama of 4 beautiful boys ages 17, 13, 10, 3 and just welcomed the newest member of the family on 3/22/2016 OUR FIRST GIRL!! :
Was not able to BF first 3 boys but now successfully and thriving

Re: Supply issues

I think the formula has a LOT to do with it. As I said, I was backed against a wall in the hospital. I had gestational diabetes also, and she had low blood sugar when born, as expected. It corrected immediately but between that and the jaundice the neonatologists really pressured me to start formula. We can't go backward, though.

Re: Supply issues

Originally Posted by @llli*catvet

I don't want to force feedings on her as we are already a little concerned about her weight.

I don't think you need to be too concerned. Your baby is still extremely young, and most breastfed babies lean out starting around the middle of the first year, as they become more mobile and devote increasing amounts of calories to things like reaching, rolling, crawling, etc., instead of lying around packing those calories on as fat. And you cannot force a breastfed baby to eat- if she's not hungry, she won't suck in a way that triggers abundant milk flow.

That being said, I really encourage you to find a way to decrease the size of your LO's bottles. 8 oz is really excessive. I don't mean that to be critical of you- I know from experience just how easy it is to overfeed a baby using a bottle! You feed the baby a normal portion and she fusses and "asks" for more, so of course you slip the bottle back into her mouth.

I have thyroid disease (hashimotos) but am tested regularly and am not on supplementation. I've been tested within the last 2 months or so.

Where were your levels 2 months ago? A lot of practitioners hew to the older guidelines which accept higher TSH levels as being in the normal range, even though newer research suggests that a narrower range, with a lower limit on TSH, is better.

Re: Supply issues

Took a bit to get my results. 12/13 FT3 2.96 (2-3.5). FT4. 0.89 (0.45-1.63) TT3. 89. (71-180)
2/6/13. Ft3. 2.82 (2.00-3.50). Ft4 (0.45-1.63). Thyroid peroxide ab 10 (0-34). Thyroglobulin ab. <20. (0-40). T3 total 106 (71-180). This is my GP doctor. She is less interested in TSH. I have that checked regularly too. I was followed regularly in preg. By my OB. I see the endocrinologist twice yearly. I have Hashimotos thyroiditis. Diagnosed by aspirate. Not on meds. All numbers ok right now. My endo said many mothers become hypo at about 6 months postpartum.

Re: Supply issues

Hi! welcome to the forum. Age does not matter with production, nor, as mommal said, does the way baby was conceived. I don't know what your hormone levels mean in terms of production. But, If you have limits on how much milk you can make due to hormonal issues then you still want to maximize your production by frequent and effective milk removal. Unless your baby has some latch issues, baby will be better than pump at this.

Size of baby is irrelevant. Bigger babies do not necessarily need more breastmilk! this is a myth. Normal milk intake for breastfed babies from about one month of age on is 25-35 ounces per day.

I suggest you find ways to nurse more frequently when with baby. Nights, weekends, whenever. I promise you cannot force a baby to nurse, and a baby will not overfeed at the breast.

A baby can be overfed with a bottle! 8 ounce bottles are too big. This causes many problems. To be supportive of breastfeeding and healthy eating, your caregiver should be cue feeding, pace bottle feeding, and bottles should have much less in them to minimize the risk of overfeeding and waste. 3-4 ounces would be a 'normal' feed at the breast at this age. If baby wants more, she can get a second bottle after a short pause to see if what she really needs is comforting.

Bottle feeding should, as much as possible, mimic breastfeeding! (even for exclusively formula fed babies.) We (society) have been getting this backwards for ages. See kellymom link on this in pp and this caregiver handout http://www.llli.org/docs/00000000000...astfedbaby.pdf

It is often more difficult for moms who are separated from baby regularly due to work etc. to maintain adequate production. This is just a fact. What helps in general is nursing baby lots when with baby, using the very best pump you can, and pumping every three hours or as close to that as possible when away from baby.

For special issues with production, I strongly suggest the book Making More Milk